Section of Gastroenterology and Hepatology, Baylor College of Medicine, 1709 Dryden Street, Suite 800, Houston, TX 77030, USA.
Gastroenterol Clin North Am. 2012 Jun;41(2):483-95. doi: 10.1016/j.gtc.2012.01.007. Epub 2012 Feb 16.
Overall, fecal markers have been found to be more accurate than serum markers. However, fecal markers are not specific for IBD and may be elevated in a range of organic conditions. Fecal calprotectin and lactoferrin can still differentiate inflammatory disease from functional bowel disorders. Comparison studies have found an overall diagnostic accuracy in IBD of 80% to 100% for both calprotectin and lactoferrin. Elevated levels are found in both CD and UC making it difficult to distinguish between these 2 diagnoses from these biomarkers alone. Both markers correlated well to mucosal healing and histologic improvement. Hence, they may be useful in monitoring response to treatment and predicting endoscopic and clinical relapse. Overall, patients with elevated markers were at higher risk of postoperative recurrence than those with normal levels. Fecal markers are useful in predicting pouchitis as well. Fecal markers are helpful as an adjunctive tool in overall evaluation of patients with nonspecific symptoms and as a management tool in those with inflammatory disease to monitor disease activity and possibility of relapse. They are less invasive than colonoscopy and can help guide management in a more cost-effective manner.
总的来说，粪便标志物比血清标志物更准确。然而，粪便标志物对 IBD 并不特异，在一系列器质性疾病中也可能升高。粪便钙卫蛋白和乳铁蛋白仍能区分炎症性疾病与功能性肠病。对比研究发现，粪便钙卫蛋白和乳铁蛋白对 IBD 的总体诊断准确性为 80%至 100%。在 CD 和 UC 中均发现升高，因此单凭这些生物标志物很难区分这两种诊断。这两种标志物与黏膜愈合和组织学改善相关性良好。因此，它们可能有助于监测治疗反应和预测内镜和临床复发。总的来说，标志物升高的患者比标志物正常的患者术后复发风险更高。粪便标志物对预测 pouchitis 也有帮助。粪便标志物作为一种辅助工具，对非特异性症状患者的整体评估和对炎症性疾病患者的管理都很有帮助，可以监测疾病活动度和复发的可能性。与结肠镜相比，它们的侵入性更小，可以更具成本效益的方式指导治疗。
